Fax Registration for SEAK Hyannis 2007

- Registration Form -

To register, CALL SEAK, Inc. at 508-457-1111, or PRINT this form and complete the requested information (neatly, please), and Fax to SEAK, Inc. at 508-540-8304, with credit card information. Or MAIL with payment to: SEAK, Inc. PO Box 729, Falmouth, MA 02541.

Please register me for:
MAIN CONFERENCE

___ 27th Annual Workers’ Compensation and Occupational Medicine Seminar ($895:July 17-19, 2007)

PRECONFERENCES

___ Workers' Compensation Legal Issues and Defense Strategies ($395:July 16, 2007)
___ ADA, FMLA, and Workers' Compensation: In Depth ($395:July 16, 2007)
___ Injured and Aging Workers: Maximizing the Fit Between Worker and Work ($395:July 16, 2007)
___ Comprehensive Assessment and Treatment of Chronic Pain ($395:July 16, 2007)
___ Advanced Presentation and Training Skills Workshop for OH Professionals ($395:July 16, 2007)
___ Work-Related Upper Extremity Disorders: Achieving Excellence ($395:July 16, 2007)
___ Disability Mgmt./Return to Work: Raising the Bar: Next Generation... ($395:July 16, 2007)

I would like to apply for the following credits (Please check as many as are applicable):

__Attorney (LAWYERS ONLY)       __Case Manager        __Disability Specialist            __MD/DO
         __ Occupational Health Nurse             __ Rehabilitation Counselor            __Nurses

priority code: web

□ I'm paying by credit card or Check Enclosed (made out to SEAK, Inc.) □

Type of credit card: ___Visa ___MC ___AmEx

Exp. Date:

Credit Card #:

Name

Name of Organization

Address

City

State

Zip

Phone

Fax

Email

Specialty

SEAK, Inc. FAX (508) 540-8304

□ I'm paying by credit card or Check Enclosed (made out to SEAK, Inc.) □
Type of credit card: ___Visa ___MC ___AmEx		Exp. Date:
Credit Card #:
Name
Name of Organization
Address
City	State		Zip
Phone		Fax
Email
Specialty